PhilHealth Annex A.1: Pre -authorization Checklist and Request for Coronary Artery Bypass Graft
Fill PhilHealth Annex A.1: Pre -authorization Checklist and Request for Coronary Artery Bypass Graft online and download the official form as a PDF, ready to print. Every input is mapped to its printed box, so IDs, dates and amounts land digit by digit in the right cells, and a value the form cannot hold is refused with the reason instead of being printed wrong.
What you will need: Case No, Last Name, First Name, Suffix, Middle Name, PhilHealth ID Number, Same as patient, Fulfilled selections criteria, If no, specify reason/s and encode, At least 19 years of age, CABG Risk Type, Stable coronary artery disease requiring ELECTIVE ISOLATED, NOT in severe decompensated heart failure by New York, NOT with severe angina by Canadian Cardiovascular Society, NO other cardiac/vascular procedures/interventions planned.
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